There’s something very different about this year’s ACOG meeting, though. Anti-abortion and anti-contraception protesters who previously were camped outside with signs vilifying obstetricians for being “child haters” are nowhere to be seen this year. Is that a sign of the times? Or a difference between having the meeting in protest-crazy San Francisco in 2010 and this year’s meeting in more conservative San Diego?

Don’t get me wrong. There still are protesters here calling obstetricians “sex criminals.” With anti-abortionists and anti-contraceptionists gone, all that were left were the anti-circumcisionists handing out cards with links to Web sites such as Doctors Opposing Circumcision (DOC).

That means there’s still a strong police presence at the doors to the convention center and workers diligently checking to see that people who come into the center are wearing registration badges. I haven’t heard of any cases of anti-circumcisionists murdering ob.gyns. as some abortion opponents have done, though.

For the record, ACOG’s policy on circumcision is essentially the same as that of the American Academy of Pediatrics. They do not recommend routine circumcision for newborn males, but advise physicians to weigh the potential risks, benefits, and costs of circumcision with the newborn’s parents.

And looking at the ACOG program, I didn’t see “Room TBD” next to the two presentations on circumcision, one of which I’ll be reporting soon: “A Cost-effective Analysis of Male Circumcision for the Prevention of HIV in the United States.” The findings may surprise you. Stay tuned.

“We will amend the criteria to make clear that disqualifying investigations must be criminal and conclusive in nature and not political,” Komen CEO and founder Nancy Brinker said in a statement issued Friday.

The uproar brought more than $3 million in donations to Planned Parenthood in just three days, but also highlights the volatile mixture of politics and medicine.

Dr. Richard Carmona recently observed that one of the most popular presentations he made during his tenure as the 17th Surgeon General of the United States did not address emerging infections, physical trauma, or national diasters, but rather the plague of politics in medicine.

“This traumatic plague of politics is more insidious and virulent than emerging infections; has potentially more morbidity and mortality than hemorrhagic shock or blunt or penetrating trauma; has virtually no diagnostic criteria; and is resistant to all therapy, especially voices of reason, substantive discussion or positions of compromise,” he said during a memorial lecture at the recent meeting of the Eastern Association for the Surgery of Trauma.

Dr. Richard Carmona Patrice Wendling/Elsevier Global Medical News

Dr. Carmona didn’t have far to look for examples to flesh out his diagnosis.

More than a century ago, public health officials’ efforts to control the bubonic plague outbreak of 1900 in San Francisco were nearly derailed by politicians who claimed that quarantine procedures, including closing the city’s harbor to incoming ships, were an over-reaction that would impede commerce and tourism, and result in the collapse of San Francisco, and possibly California. The Surgeon General who intervened based on the scientific evidence was labeled a heretic and asked to resign.

In the 1980s, similar calls were made after former Surgeon General Dr. C. Everett Koop refused to back down from statements that HIV could be prevented. At the time, Dr. Carmona reminded the audience, senior elected officials were telling the American public that HIV was God’s way of punishing homosexuals.

In the 1990s, the tenure of Surgeon General Dr. Joycelyn Elders was cut short after controversy erupted over a 1994 speech at the United Nations World AIDS Day that included remarks that masturbation was a normal part of sexuality and that abstinence-only education was “child abuse.”

During his own term under President George W. Bush, Dr. Carmona said, abstinence-only became the mantra of the administration, “based solely on ideological and theological concepts, and not science.

“Science had really demonstrated that abstinence alone was a failed proposition,” Dr. Carmona said. “Ironic, that an administration that was repeatedly caught up in the issue of abortion did not see the connection that comprehensive sex education was the best method to prevent STDs, unwanted pregnancies, and therefore abortions. As Surgeon General, this is a science-based position I have always held.”

Dr. Carmona, the only Surgeon General to be unanimously confirmed to the position in over 200 years, said the trauma of politics and its preventable deleterious outcomes are owned equally by politicians on both sides of the aisle.

He pointed out that over-the-counter sales of Plan B stalled under the Bush administration before gaining limited approval in December 2006, but fared no better seven years later under the more liberal Obama administration. In December 2011, HSS Secretary and Democrat Kathleen Sebelius overruled the FDA’s decision to make the emergency contraceptive available, without prescription, to girls of all childbearing ages. While Sebelius cited a lack of conclusive data, Dr. Carmona said it was the administration’s desire to avoid a political battle in the face of an upcoming election.

“The immunization for preventing the continued viralness of political trauma is transparency, full disclosure, accountability for elected officials, a citizenry that is informed and participatory, coupled with civil discourse of complex issues,” he said.

The voters in Mississippi soundly rejected an attempt to change the state’s constitution to grant legal rights to embryos, starting at the time of fertilization. After intense campaigning by advocates on both sides of the abortion debate, about 58% of voters came out against the ballot measure.

The defeat of the so-called “personhood” amendment may have had less to do with traditional abortion politics, and more to do with its potential impact on the availability of birth control and fertility treatments. Dr. Douglas Laube, the board chair for Physicians for Reproductive Choice and Health, who opposed the measure, said that because the personhood amendment called for establishing rights at the time of fertilization, it would likely have meant that birth control options that prevent implantation would have been disallowed. That includes emergency contraception and intrauterine devices (IUDs), he said.

An IUD like this one might have been outlawed under the personhood amendment. Courtesy Wikimedia Commons/Gloecknerd/Creative Commons License.

In-vitro fertilization also could have been impacted. Supporters of the personhood amendment said the the availability of IVF wouldn’t have been affected, but they acknowledged that the amendment would have barred the destruction of embryos by fertility clinics since it defined a person as “every human being from the moment of fertilization, cloning, or functional equivalent thereof.”

Jennifer Mason, a spokeswoman for Personhood USA, which is promoting similar constitutional amendments around the country, said the change could end up being better for everyone. Instead of destroying excess embryos, fertility clinics could freeze them for future implantations or the embryos could be adopted by infertile couples. But the American Society for Reproductive Medicine and the Society for Assisted Reproductive Technology didn’t agree. In advance of the vote, the groups wrote to the Mississippi Secretary of State citing the uncertainty that any particular embryo will develop to become a person and calling it “unreasonable and imbalanced to give constitutional rights to fertilized eggs or embryos.”

The personhood debate is far from over. Personhood USA boasts that it is active in all 50 states and that the group plans to keep pursuing state constitutional amendments to outlaw abortion.

I encountered a weird, sad and somewhat frightening thing when covering the obstetricians’ and gynecologists’ big annual meeting this year — something I haven’t seen in my 20 years of medical news reporting, including many assignments to this very meeting.

It took me awhile to recognize it. The first day, as I was trying to find the room number for a talk I wanted to cover, I noticed that there was a “mistake” in the program book. The room number for that particular session was missing. The next day, two more sessions that I wanted to cover had the same “problem” — no room number.

So I asked for help from staff in the press office, and they seemed surprised to see these “errors” in the program too. But they knew who to call, and got me the room numbers, explaining that the omissions from the program were for “security” reasons.

Then it hit me that the link between each of the “missing” sessions that I’d hoped to attend was that they all were about contraception. Not even abortion, mind you, just contraception.

Throughout the meeting, protesters took up posts outside the convention center, haranguing attendees with shouts through bullhorns and enlarged anti-abortion signs and photos of fetuses, even one sign that accused these baby-loving physicians of hating children.

I’ve seen that before, but never felt threatened. Perhaps I shouldn’t have felt so safe, considering that eight abortion providers have been murdered since 1993. Clearly, the meeting organizers were taking no chances. The fact that they felt they needed to protect contraception sessions is a sad sign of our violent times, and it occurred to me that the nervousness it generated in me must be something that many Ob.Gyns. live with every day.

Congress took a holiday last week to honor America’s military heroes both past and present, but the veterans of the health reform debate did not pause.

Photo by Flickr user US Army Africa

A breakaway group of physician organizations mounted a challenge to the American Medical Association’s backing of the House-passed reform bill. Activists on both sides of the abortion issue took up their positions, hoping to persuade the Senate to either dump or keep the House amendment barring abortion coverage in the public insurance exchange.

And all hoped to have some last-minute influence over the Senate, which was expected to unveil its final bill by Tuesday, Nov. 17.

The House approves a health care reform bill, but Democrats splinter over an abortion provision. The bill receives support from the American Medical Association, but some surgeons’ groups beg to differ. And physicians of all specialties await a Congressional fix to the Medicare SGR formula.

It’s all in this week’s Policy & Practice podcast. Take a listen and let us know what you think.